title: Influence of socioeconomic factors on delays, management and outcome amongst patients with acute myocardial infarction undergoing primary percutaneous coronary intervention.
abstract: OBJECTIVE
  The outcome after primary percutaneous coronary intervention (pPCI) for ST-elevation myocardial infarction (STEMI) is strongly affected by time delays. In this study, we sought to identify the impact of specific socioeconomic factors on time delays, subsequent STEMI management and outcomes in STEMI patients undergoing pPCI, who came from a well-defined region of the French part of Switzerland.
  
  
  RESULTS
  A total of 402 consecutive patients undergoing pPCI for STEMI in a large tertiary hospital were retrospectively studied. Symptom-to-first-medical-contact time was analysed for the following socioeconomic factors: level of education, origin and marital status. Main exclusion criteria were: time delay beyond 12 hours, previous treatment with fibrinolytic agents or patients immediately referred for coronary artery bypass graft surgery. Therefore, 222 patients were finally included. At 1 year, there was no difference in mortality between the different socioeconomic groups. Furthermore, there was no difference in management characteristics between them. Symptom-to-first-medical-contact time was significantly longer for patients with a low level of education, Swiss citizens and unmarried patients, with median differences of 23 minutes, 18 minutes and 13 minutes, respectively (p <0.05). Nevertheless, no difference was found regarding in-hospital management and clinical outcome.
  
  
  CONCLUSIONS
  This study demonstrates that symptom-to-first-medical-contact time is longer amongst people with a lower educational level, Swiss citizens and unmarried people. Because of the low mortality rate in general, these differences in delays did not affect clinical outcomes. Still, tertiary prevention measures should particularly focus on these vulnerable populations.
authors.affiliation: Cardiology, University Hospital Center (CHUV), Lausanne, Switzerland. fournier.stephane@gmail.com
authors.forename: Stephane
authors.initials: S
authors.lastname: Fournier
authors.forename: Olivier
authors.initials: O
authors.lastname: Muller
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Ludman
authors.forename: Nathalie
authors.initials: N
authors.lastname: Lauriers
authors.forename: Eric
authors.initials: E
authors.lastname: Eeckhout
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D004522:Educational Status; D004641:Emigration and Immigration / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D017533:Marital Status / Q000706:statistics & numerical data; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality / Q000628:therapy*; D062645:Percutaneous Coronary Intervention / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012959:Socioeconomic Factors; D013557:Switzerland; D062606:Tertiary Care Centers; D013997:Time Factors; D061665:Time-to-Treatment / Q000706:statistics & numerical data*; D016896:Treatment Outcome